The C Word
The C-Word is an 8th season episode of House which first aired on April 30, 2012. When the team takes on the case of Emily, a six-year-old girl who has numerous preexisting health problems, they must work with her mother Elizabeth, who is a doctor who specializes in her daughter's condition. The team must also deal with the battles raging between Emily's mother and father who have conflicting views on how to handle her health issues. When searching the family's home for clues to Emily's illness, the team realizes that Elizabeth's determination to cure her daughter could be the very thing that is killing her. Meanwhile, House and Wilson deal with Wilson's stage two cancer at House's apartment. Wilson feels that going forward with the more radical treatments first would be the best way to deal with it instead of dying a slow death, and this puts his life in jeopardy. This is the second and last episode to be directed by Hugh Laurie, after he did it in the episode "Lockdown" (from season six). Recap A father and daughter are playing at an amusement park, and she wants to go on the merry-go-round by herself. Her father agrees on the condition she not tell her mother. However, as she goes around, her father notices that she’s looking woozy and developing a nosebleed. The next thing he knows, she’s missing. He shouts at them to stop the ride and jumps on it while it’s still moving to look for her. He finds her on the interior of the ride unconscious and screams for help. House finds Wilson in a lounge looking at scans of his thymoma. Wilson wonders how House found him, and House says he followed him there. Wilson says he doesn’t need another doctor, and House insists he’s there as a friend. He also notes that he’s tried to throw Wilson out several times when he wanted to be alone and it’s never worked. Wilson concedes and lets House stay after House promises not to give him any advice. Taub is wondering why House is taking time off for the first time in years, but Adams says it’s just because House wants to be there for Wilson. Taub is still skeptical. Foreman comes in with the case. The patient has two copies of the gene that causes ataxia telangiectasia. The other doctor, a developmental geneticist from Johns Hopkins Medical School who is with him explains that although she has symptoms of that condition, her presentation is different. Chase realizes the doctor is the patient’s mother, but she reassures them she’s there as a doctor, not her mother. Taub suggests her nosebleed and breathing problems are a complication of her telangiectasia, but the mother dismisses the suggestion as the patient is too young to be showing symptoms that severe. She also checked out the patient’s lungs two days before and she was fine. Adams guesses head trauma from the fall, but the mother dismisses that as well, saying if it were an easy diagnosis, she wouldn’t need them. Park suggests granulomatosis with polyangiitis and the mother agrees it’s a good fit. She goes to prepare the patient for an MRI because telangiectasia patients are sensitive to x-rays and walks out. The team is stunned by her behavior, but Foreman reassures them that she knows more about her daughter’s condition than anyone and that she will be an asset. Chase is sceptical, but Foreman tells them they have to work with her. Wilson’s doctor is explaining they will have to give him radiation therapy before trying to remove the tumor with surgery because it has started to spread. However, Wilson realizes that with such conservative therapy, if the tumor doesn’t start to shrink by the time they try chemotherapy, it will be terminal. The doctor tries to reassure him that in 75% of cases like his, the radiation alone will destroy the tumor. Wilson counters that because the tumor has started to spread to surrounding tissue, it’s too late for radiation alone. He wants radiation and chemotherapy together. The doctor opposes this course of action because it will put too much of a stress on his immune system. Wilson says he’s getting a second opinion. The doctor counters that Wilson has recommended this exact course of action for dozens of his own patients, but Wilson gets up to leave and says he wants a doctor with ‘’balls”. The doctor asks House to speak to Wilson, but House backs Wilson. The doctor says that Wilson has to be more objective about his own treatment, but House agrees the doctor has no balls. The parents are arguing about the father having let the patient on the merry-go-round when Taub and Adams arrive. The mother goes to wake up the patient and gives her a toy penguin. Adams tries to make a joke about what “MRI” means, but the patient already knows what it means. House is beating Wilson badly at combination of “Battleship” and “Beer Pong” and asks why Wilson freaked out with his oncologist. Wilson says it’s not freaking out to ask for a second opinion. However, House counters that Wilson should know his doctor was right and he should be in radiology, not looking for another doctor. He reminds Wilson that without treatment, the tumor will only get larger. Wilson says he doesn’t want House’s advice and walks out. Adams and Taub do an MRI on the patient. She admits she was only pretending to sleep while her parents argued. Taub lies to the patient to tell her that he argues with his wife in front of his daughters all the time and they’re all fine. Adams wonders about the behavior of the patient’s mother. However, as Taub responds, the patient cries out in pain. As they get her out of the MRI, they note her fingers and toes are turning dark - the sign of there being no circulation. She calls out for her father. They manage to restore circulation before there is any permanent damage. The team suggests the cold or stress could have set it off, but the mother becomes convinced that the father’s new apartment might be harboring heavy metals. She goes to do an environmental scan. However, Chase counters that lupus is probably more likely. The mother counters that she knows best as the patient’s mother, but Chase counters that she earlier said she was there as the patient’s doctor. She says that since they need her consent to treat the patient, it doesn’t matter. She tells them to start chelation therapy. When she leaves, Chase tells the team they have to start treating her like any other mother. Chase and Adams do an environmental scan of the mother’s home. In the basement, they find an entire lab set up, full of hazardous chemicals and pharmaceuticals. Adams doesn’t think the mother would allow the patient down there, but Chase finds a playroom set up. They find a supply of LEX-2, an experimental antibiotic that is supposed to correct errors in the genes that cause ataxia telangiectasia. Adams thinks she must be testing it on lab rats, but Chase points out there is no sign of those and the only cage in sight is the playroom. Wilson is in his office when House come in. Wilson has a headache and tries to send House away, but House wants to talk about second opinions. House has found that Wilson has seen four other doctors, all who have given him the same advice. He’s also found out that Wilson wants a dose of chemotherapy that has a good chance of killing him. House wondered why Wilson hadn’t told him, then realized it was because House would have tried to stop him and because Wilson had already found a doctor willing to co-operate, and the only doctor stupid enough to agree is Wilson himself. House opens a box and finds the chemotherapy drugs. The only thing House doesn’t know is where Wilson is planning on treating himself, and Wilson admits he stockpiled the equipment in his condo. House goes to destroy the chemotherapy drugs, but Wilson stops him. He argues he’s healthy - trying something extreme is more likely to kill him once he‘s really ill. House counters that the therapy is about as likely to kill him as the thymoma. Wilson goes through the gifts in his office from all the dead patients who had excellent chances of survival. He says he can’t stand the thought of dying slowly in a hospital. House calls him an idiot who is going to die. He then agrees to do it at his apartment. Foreman confronts the mother with the LEX-2 they found. She admits she used it on her daughter. She also insists the treatment is safe - she tested the drug on herself with no adverse effects, and because respiratory infections are common in AT patients, it is likely that Emily would not have survived the winter without it. However, Foreman counters that the FDA approves drugs for a reason. Another team has linked long-term use of LEX-2 to kidney failure in rodents. The patient needs a kidney biopsy. At 221B Baker Street, they prepare Wilson for treatment. House starts off with a couple of martinis and a toast to stupidity. He also reminds Wilson about the side effects of the treatment. Wilson hands him the chemotherapy drugs. They prepare for the biopsy on the patient. Her father comforts her, but she complains her chest hurts. She starts coughing up blood and Chase realizes it’s not a kidney problem. Wilson tells House he appreciates the risk House is taking. House says he’s going to dump Wilson’s body somewhere if he dies. Wilson starts having muscle spasms. House notes that they’re early. Wilson says he always thought when he got old he would have a wife and children to take care of him. House wonders if he’s in Wilson’s will and tells Wilson he’s got all he needs. He then shares some intravenous painkillers with Wilson. The team start a new differential. Taub suggests a clot from a deep-vein contusion from the fall. The mother wants to start heparin. However, they all get paged. They arrive at admitting to find the father checking the patient out of the hospital. The parents get into another argument until Chase stops them. Chase takes the patient back to the room. Taub explains that the patient’s fall may be the cause of their problems. When the mother says they should stop blaming each other, he becomes enraged that she would compare him letting the daughter on a ride to her experimenting on her. He also notes that she’s totally out of touch with her daughter and the penguin toy she gave her reminds her of nightmares she’s been having. She counters by asking what her blood type is and what kind of genetic defect she has. The father tells her to just make the patient better. Wilson wakes up and finds a young boy in the room with him. He calls for House. Wilson realizes it’s a hallucination of one of the patients he lost. Wilson wonders if he’s dead, but House replies he’s not dead yet. They give the patient another MRI. Taub tells the mother that he too worked in a research lab and that you can get overly focussed. Park announces that the patient’s lungs are fine. However, Taub notices jaundice, indicating liver involvement. They do find a blockage in the hepatic vein that’s the most likely cause of the liver failure. However, the mother has become convinced that the patient’s genetic condition is to blame. Taub tries to reassure her that they still have to work through their process, but she admits she shouldn’t be there. After she leaves, Taub suggests advanced Lyme disease. Park counters that they would have seen it in blood tests, but Chase realizes that not only would they not have picked it up in tests if it were contained in her organs, it explains all the symptoms except her original nosebleed. Adams realizes that the LEX-2 is effective against Lyme disease, but she hasn’t been treated with it since she arrived at the hospital. That’s what allowed it to spread. They go to start the patient on amoxicillin. Wilson is vomiting heavily. House lies and tells Wilson he looks good. Wilson asks about his white blood cell count - it’s low and still dropping. House is out of morphine, so he gives Wilson some Vicodin. He reassures Wilson he has lots, but it soon becomes clear that he’s running out and House grabs some booze to deal with his own pain. They come to the parents to explain their ideas, but the mother claims she would have seen earlier signs of it and that the patient has never even been in the woods. However, the father admits he took her to the woods once and didn‘t tell the mother. The mother becomes resigned to the fact they can’t protect her from everything. Wilson tears out his intravenous lines to go use the washroom. House goes to help and Wilson tells him to leave him alone. Wilson finally gets angry that as an oncologist, he has gotten cancer. He’s also mad about how he’s misled his patients by reassuring them and says he should have acted more like House - at least that way he would feel he deserved cancer., They go to perform a lumbar puncture on the patient to confirm Lyme. The patient is worried that her parents are always fighting about her and maybe they will get back together when she dies. All of a sudden, she complains she can’t move her arm. She’s having a stroke. House tells Wilson he has tachycardia, low blood pressure and his white blood cell count is in the tank. He needs to go to the hospital, but Wilson refuses. He says he would rather die in House’s apartment than an ambulance or hospital. He begs House that he won’t let that happen. House promises. The stroke rules out Lyme disease. Park notes that the symptoms are textbook for a pulmonary embolism, but there is no sign of a clot. They start to wonder what else could cause the same problems. The lumbar puncture was clear for a fungus or any other type of infection. They can’t reach House and Chase just tells them to come up with ideas. Park notes that certain types of cancer are more common in telangiectasia patients, but it wouldn’t progress that quickly. However, Chase realizes a tumor could cause a blockage. He realizes an atrial myxoma would explain all the problems - it would block blood flow and parts of it could break off to cause the blockages. Chase plans surgery to remove it. Wilson wakes up the next morning. House hands him a glass of water. Wilson goes to apologize for what he said, but House says he stopped listening. Wilson asks for a chance to go to the bathroom by himself, but House has to help him get there. Wilson realizes House is in a lot of pain and lied about having lots of Vicodin. Wilson asks if what he went through with the pain for two days is what House has to go through every day. House nods. Wilson says it must suck. House says at least he doesn’t have cancer. The patient recovers from surgery, and the tumor is benign. Her mother tells her she’s still sick, but her father says that being sick never stopped them from doing stuff before. They plan to go to the aquarium and the mother asks if she can come along. House and Wilson return to the hospital. They agree to meet for lunch. House smiles as Wilson goes to his office. Wilson arrives at his office to find a video on his computer. When he plays it, it’s stills of him, House and two girls in bikinis dressing him up in all types of holiday get-ups while he’s unconscious. Wilson starts laughing uproariously. Major Events *Wilson rejects conventional therapy for his thymoma. Instead, he goes with radical chemotherapy with House’s help. He manages to survive the treatment. Zebra Factor 4/10 Myxomas are the most common type of primary heart tumor. In addition, they can usually be detected with just a stethoscope as they make a distinct flopping sound. Trivia & Cultural References *”The C Word” is, of course, a euphemism for cancer. Up until about the 1970s, cancer was seldom discussed in public, which led to a great deal of misunderstanding about the disease. *Spring Break is a one week period where classes are suspended at universities during the early part of spring. Most students use it as an opportunity to take a vacation in sub-tropical places. *Battleship is a board game dating to 1967, but it existed as a commercially produced pencil and paper game in 1943, but existed as a game since the early 20th century. House and Wilson were playing Battleship with a slight modification, where the players must drink shots each time they were hit. House shot for square B-9 which is a phonetic play on "benign", a reference to Wilson's tumor. It is also a goof, since their gameboard shows they were playing on a 7x7 grid, making the B-9 square unavailable. *Beer Pong is a drinking game where teams attempt to toss ping-pong balls into beer cups. *Trinity Park is fictitious. *This episode was directed by Hugh Laurie, who portrays House in the series. It's the second time he directs an episode. *The song playing over Wilson’s Spring Break video is Any Way You Want It by Journey. It reached #23 in 1980. *A minyan counts 10 people, the minimum amount required for certain religious procedures in the Jewish tradition. Quotes Video Category:Episodes Category:Season 8